Over a remarkable span of 31 years, San Francisco has had a series of either gay or lesbian health directors. That track record came to an end Tuesday, when Mayor Daniel Lurie introduced Daniel Tsai as his choice to lead the city's health department with a budget of more than $3 billion.
Tsai succeeds gay former health director Dr. Grant Colfax, who resigned February 7 after leading the sprawling agency for six years. At one time Massachusetts' Medicaid Director, Tsai had overseen the U.S. Centers for Medicare and Medicaid Services during the Biden administration.
In that role, to which Tsai was named in 2021, he was credited with strengthening care for mental health and substance use, while pioneering interventions for individuals who are homeless with medical and behavioral health conditions, noted Lurie in formally introducing Tsai February 11 as his choice for the high-profile position of leading the San Francisco Department of Public Health. The city's health commission had unanimously nominated Tsai on Monday.
"It's going to take creativity, compassion, and collaboration to tackle the city's drug crisis, and that's exactly what Dan Tsai brings to the table," stated Lurie. "Dan's experience is broad, but his commitment to patients and communities is clear throughout. I am excited that he is bringing that expertise and dedication to San Francisco."
Tsai oversaw the Bay State's Medicaid office for six years. Prior to that post, he was a partner in McKinsey and Company's health care and public sector practices.
"San Francisco's health care system is storied and has some of the best facilities and people in the nation. I am committed to collaborating with the community to ensure every individual and family we serve can access and receive world-class health care and outcomes," stated Tsai. "This is all the more urgent given the opioid and homelessness crisis, and I look forward to partnering with stakeholders and individuals with lived experience to find new, data-driven approaches to tackling this important challenge compassionately and effectively."
It is believed that Tsai, who has no medical training, is the city's first Asian American health director. (The position does require the person to have a medical degree.) The mayor's office has yet to respond to the Bay Area Reporter's inquiries on what is Tsai's first day in the job and how much is his salary.
Past out directors
Dating back to 1994, when lesbian Dr. Sandra Hernandez, who had been heading up the city health department's AIDS Office, was tapped to be San Francisco's health director, there has been a succession of out health directors, most with experience caring for people living with HIV. Succeeding Hernandez in 1997 was Dr. Mitch Katz, a gay man.
He was followed by lesbian Barbara A. Garcia, who resigned in 2018 after questions were raised about a contract granted to her wife's employer. It resulted in Colfax, who had been serving as Marin County's health and human services director, to be lured back to the city's health department, at which he had been its HIV prevention director between 2007 and 2012.
Gay District 6 Supervisor Matt Dorsey, who is living with HIV, joined Lurie and a number of his board colleagues, including queer District 9 Supervisor Jackie Fielder, at the news conference held Tuesday to introduce Tsai to the city. Dorsey told the B.A.R. he expects Tsai to maintain San Francisco's reputation as being a leader in the fight against AIDS and providing cutting-edge care to people living with HIV.
"I think anyone with the background Daniel Tsai has had at MassHealth will bring enormous expertise in AIDS/HIV care, given that Massachusetts has for decades been among the national leaders in that realm (alongside San Francisco)," noted Dorsey in a texted reply. "I've been assured by the Lurie administration that this pick is well-aligned with the mayor's recovery-focused approach to our drug crisis – and that's a priority I strongly share. So, I'm excited to get to work with Director Tsai and his team, and I'll be reaching out to him this week on drug policy legislation I'm in the process of drafting right now."
Tsai's tenure is coinciding with a multi-pronged attack by the Trump White House on various health programs and care beneficial to the LGBTQ community. The Republican president is attempting to restrict gender-affirming care for youth, ended financial support for global AIDS programs, and is attempting to freeze funding for nonprofit service providers across the country, many of which deliver vital health care to LGBTQ individuals.
Reached for comment about Tsai, lesbian San Francisco health commissioner Susan Belinda Christian, a lawyer at the city's district attorney's office, referred the B.A.R. to the oversight body's secretary, who forwarded the paper's interview request with Christian to the health department's press office. It did not respond by the paper's print deadline Wednesday morning.
Former health commissioners who are both living with HIV Dan Bernal, who is gay, and Cecilia Chung, who is transgender, did not respond to the B.A.R.'s request for comment about the new health director. After the B.A.R. went to press February 12, San Francisco Community Health Center CEO Lance Toma responded to the paper's request for comment.
He had met Tsai when he and other federal health officials came to San Francisco in November 2022. Toma took part in a meeting with other local health center leaders with Tsai and the next day provided him a tour of his agency's facilities in the city's Polk Gulch neighborhood.
"I am extremely excited to be able to work with our new director of public health and proud to see that there are API individuals in the mayor's leadership," said Toma, himself a member of the Asian and Pacific Islander community.
He noted that Tsai will report to Lurie's Chief of Health, Homelessness, and Family Services Kunal Modi, another API community member. It will be up to LGBTQ service providers, said Toma, to ensure City Hall remains focused on the community's health care needs.
"From what I know and the meeting he had with us, he was so interested and invested in the work that the San Francisco Community Health Center did and took time to come meet with our staff, talk with them and hear the challenges with respect to both the LGBTQ community, trans community and homelessness community," Toma recalled of Tsai's visit three years ago. "I am very hopeful."
Toma, a gay man, last Friday announced that his agency had its federal funds in the hundreds of thousands of dollars for programs serving trans youth of color "immediately terminated" by the Trump administration.
"These specific programs support safe spaces in San Francisco and Oakland to access HIV, STI, and Hep C screening and testing services, as well as linking our clients to more comprehensive health care services," noted Toma in a February 7 email. "A temporary restraining order was issued by a U.S. District Court which gives us a bit of breathing room to continue for now, and yet, we remain chilled to the bone."
Cleve Jones, who is living with HIV and is a longtime leader in the LGBTQ community and labor movement, told the B.A.R. he isn't familiar with Tsai or his medical career. Concerned about the Trump administration attacking Medicare and Medicaid, Jones surmised Tsai's experience with those programs could be valuable as health advocates locally and across the country fight to protect those federal programs.
"I would say any new health director faces some significant challenges across the board," said Jones. "As an HIV activist and long-term survivor, I am very, very concerned about the Trump administration's attacks on health care funding, and we are going to see how it plays out."
Longtime gay politico Tom Ammiano told the B.A.R. that defending care for the city's transgender community needs to be a priority for Tsai moving forward. Like Jones, Ammiano said he didn't know much about Tsai and hoped he would prioritize having face-to-face meetings with the city's LGBTQ political clubs as one way to introduce himself to the local queer and trans community in the coming weeks.
Noting he hails from liberal Massachusetts, where Tsai and his wife, who have two sons, had lived in the college town of Cambridge outside Boston, Ammiano said he is giving Tsai the benefit of the doubt as he takes on his new role.
"We were hit pretty hard by AIDS and we still have an issue with HIV, so the thing is there is always a lot to learn about San Francisco. We are so unique," said Ammiano, a former supervisor and state lawmaker. "I would hope he is a fast learner."
With his trademark humor as a comic, Ammiano added, "This is San Francisco, so when the neurosurgeon he meets is also a drag queen, we want him to be all good with that. We are a unique city."
UPDATED 2/12/25 with comment from Lance Toma.
Web Extra: For more queer political news, be sure to check http://www.ebar.com Monday mornings for Political Notes, the notebook's online companion. This week's column focused on a report about LGBTQ youth nonprofit service providers in Washington state.
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Got a tip on LGBTQ politics? Call Matthew S. Bajko at (415) 829-8836 or email [email protected]
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